Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 007448 | CT |
NPI | 1174561005 |
---|---|
Provider Name | Ms. Laurie Ann Wingard |
First Address | West Haven, CT 06516-2770 |
Second Address | West Haven, CT 06516-2770 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2006 |
Last Update Date | 13/07/2007 |